Primary Care Coding Alert

Question: This is the time of year when our office sees a lot of school, camp and bus driver physicals. We have tried using a V-code, along with 99213 for a problem-focused visit, but it was denied. We have considered using a preventive evaluation and management (E/M) code, but this doesnt describe the service either. How should we bill these situations?

California Subscriber

Answer: Camp, school and employment physicals are seldom paid for by any commercial or government insurance program, regardless of the level of care you bill. If, these physicals are performed as part of an annual screening exam, however, they may be paid but only if billed with the appropriate diagnosis code and if the individual has this type of coverage.

You may try two strategies to help minimize the hassle, paperwork and lost revenue, and enhance your image in the community:

1. When you are conducting exams for bus or other commercial drivers, you may want to make arrangements with the employer to pay for the cost of the exam directly. Set up a corporate account contractual agreement with your local school district, for instance, whereby you provide their physicals for a contracted fee. Bill the school district and thus avoid using codes altogether.

2. Because camp, school and sports physicals are not paid by insurance, provide these at a significantly reduced rate (i.e., $35) and let the patient know up front that they will be financially responsible. Also, conduct free sports physicals several times a year. They are usually held in a hospitals auditorium or at a school. Volunteer doctors and nurses perform the necessary exams.

These can be a lot of fun, and this opportunity promotes physicians. It is a community service, so local newspapers give free advertising. It is a win/win situation the patients are grateful for the free service, and physicians often gain new patients.